Proteomics may help discover novel biomarkers and underlying mechanisms for cardiovascular disease. This could be useful for childhood cancer survivors as they show an increased risk of cardiovascular disease. The aim of this study was to investigate circulating cardiovascular proteins in young adult survivors of childhood cancer and their relationship to previously reported subclinical cardiovascular disease.

Ninety-two cardiovascular proteins were measured in 57 childhood cancer survivors and in 52 controls. For proteins that were significantly different between childhood cancer survivors and controls, we performed correlations between protein levels and measures of peripheral arterial stiffness (carotid distensibility and stiffness index, and augmentation index) and endothelial dysfunction (reactive hyperemia index).

Leptin was significantly higher in childhood cancer survivors compared to controls (normalized protein expression units: childhood cancer survivors 6.4 (1.5) versus 5.1 (1.7), p < 0.0000001) after taking multiple tests into account. Kidney injury molecule-1, MER proto-oncogene tyrosine kinase, selectin P ligand, decorin, alpha-1-microglobulin/bikunin precursor protein, and pentraxin 3 showed a trend towards group differences (p < 0.05). Among childhood cancer survivors, leptin was associated with anthracycline treatment after adjustment for age, sex, and body mass index (p < 0.0001). Higher leptin correlated with lower carotid distensibility after adjustment for age, sex, body mass index, and treatments with radiotherapy and anthracyclines (p = 0.005).

This proteomics approach identified that leptin is higher in young asymptomatic adult survivors of childhood cancer than in healthy controls and is associated with adverse vascular changes. This could indicate a role for leptin in driving the cardiovascular disease burden in this population.

There is no cure for dementia due to non-Alzheimer’s disease (non-AD), and current treatments are symptomatic. Noninvasive brain stimulation therapies such as transcranial magnetic stimulation (TMS) are increasingly being investigated to improve cognitive function in dementia. We conducted a systematic review to investigate the effectiveness of TMS on cognition in non-AD dementia.

Comprehensive search of databases (Medline, Embase, Cochrane, APA PsycINFO, Web of Science, and Scopus) from 2000 to February 2023 using keywords related to TMS and dementia (PROSPERO, CRD42022326423). Here we report outcomes from randomized controlled trials (RCTs) of TMS on non-AD dementia populations.

In total, 20 RCTs comprised of 660 patients, mean age 62 years (range 46-71). Diagnostic groups include stroke (n=8), Parkinson’s disease (n=6), Frontotemporal dementia (n=3), Huntington’s disease (n=2) and Progressive non-fluent aphasia (n=1). The most common site of stimulation was left (L) dorsolateral prefrontal cortex (DLPFC, n=13); other sites were primary motor cortex (n=2); Right (R) Broca's area, Brodmann area, Contralesional pars triangularis, R Inferior Frontal Gyrus (IFG) (all n=1); and multiple sites in 1 RCT (L and R IFG, L superior frontal gyrus, L DLPFC, L and R right anterior temporal lobe, supplementary motor area, anterior cingulate, and vertex). Studies used both low (1Hz, n=5) and high (50Hz, n=5) frequencies, or other high (5Hz, 10Hz, 20Hz) or combination low/high frequencies. Frequent duration of treatment was 10 days (n=7), range 1-40. Of 20 studies, 19 (95%) demonstrated improvement of global cognition (on MoCA, MMSE) and specific cognitive domains (learning and memory, language, executive function, problem-solving, attention, reaction time). The only RCT with no effect utilized a single session intermittent theta burst stimulation on the LDLPFC on PD patients. Adverse events in 7 studies included headaches (most common), dull skull pain, dizziness, insomnia, fatigue, anxiety, temporary decrease in hearing, and temporary decreased mental clarity.

There is favorable evidence that rTMS improves global and specific cognitive domains in non-AD dementia. Left DLPFC is the most common stimulation site, both low- and high-frequency are utilized, and 10 sessions is frequently used. Further studies are needed to determine optimal TMS treatments in cognitively impaired populations

Agitation and aggression (AA) occur frequently in patients with dementia (PwD), and cause distress to PwD and caregivers. This study will investigate whether physiological parameters, such as actigraphy, heart rate variability, temperature, and electrodermal activity, measured via wearable sensors, correlate with AA in PwD. It will also explore whether these parameters could be compiled to create a pre-agitation biometric marker capable of predicting episodes of AA in PwD.

This study will take place at Ontario Shores Centre for Mental Health Sciences. Thirty inpatient participants who are inpatients, males, and females, aged 60 or older, with clinically significant AA, and diagnosis of Major Neurocognitive Disorder will be recruited. Participants will wear the device for 48 to 72 hours on three occasions during an 8-week study period. Participant demographics and clinical measures used to assess behavior will be collected at specific time intervals during the study period.

Ceiling mounted cameras and clinical data are collected to annotate episodes of AA, which will allow identification of peripheral physiological markers “signature” unique to the patient

the algorithm connecting wearable devices, cloud and cameras was tested on healthy volunteers and demonstrated feasibility and reliability. The feasibility of implementation in PwD has been demonstrated in our sample of PwD previously in a sample of 6 participants. Feasibility in this larger sample will be assessed. Correlation analysis between physiological measures, camera capture of agitation onset and clinical measures will be calculated to identify agitation events and pre-agitation triggers. Various machine learning and features extraction/exploration techniques will be used to test whether physiological measures can detect exact time of agitation and predict pre-agitation triggers. This study will provide a reasonable estimation of sample size needed to detect a meaningful effect size, which will be determined from the prediction model.

Early detection of AA in PwD will allow caregivers to offer timely and personalized interventions which will help avoid crises and critical incidents and improve quality of life in PwD and their caregivers.

To user-test a recovery-oriented, clinician-facilitated, web-based, self-management intervention accessible via mobile device: ROAD MAP. The initial programme theory underlying this research is that supporting the experiences of CHIME (connectedness, hope and optimism, identity, meaning in life and empowerment), in persons living with dementia (PLWD) will have health-promoting benefits for the PLWD.

The intervention will be delivered to 20 dyads of community-dwelling PLWDs and their carers via a five-week, online, recovery-based curriculum. Five convenience-sampled occupational therapists (OT) will be trained online in a 10-hour training programme to deliver the intervention. All data collection instruments are informed by realist evaluation (RE) methodology and enquire into initial programme theories (IPTs) used to develop the curriculum and the ROAD MAP digital tool. Data collection, between January and March 2023, will occur during both the OT training and the five-week pilot study. The OT facilitators will provide qualitative feedback on the ROAD MAP technology. Data will be collected via pre-post self-completion forms, semi-structured interviews, a focus group, and weekly guided reflective journal. PLWD’s self-reported, user experience will be live polled within the weekly one-hour long sessions of the pilot. Their digital usage analytics will be generated by the MyGuide platform on which the ROAD MAP intervention is built. These data will be manually screened for IPT relevance and used to test emerging programme theories.

All data will be collected by end of March 2023 and analysed by end of May 2023. NVivo will be used to generate refined programme theories according to RE methodology. This will provide evidence of plausible, causal context-mechanism-outcome configurations which may optimize the refined version of the ROAD MAP digital intervention, curriculum and facilitator training methods.

This study will increase knowledge of a methodology for developing useable and acceptable recovery-oriented telehealth tools for PLWD. This intervention could directly enhance the education of health care professionals and improve the equitable delivery of dementia services.

Social functioning is fundamental to human experience. The profound social functioning impairments affecting people with dementia are distressing to them and their families and account for significant individual, family and societal burden. There are no effective treatments that improve this major aspect of dementia, so there is urgent need to characterise social functioning decline in dementia and its consequences to inform future therapeutic approaches. In this symposium, an international panel will present perspectives on social functioning in dementia from across the disease course.

Older adults have low levels of mental health literacy relating to anxiety which may contribute to delaying or not seeking help. Lifestyle interventions, including physical activity (PA), have increasing evidence supporting their effectiveness in reducing anxiety. The COVID-19 pandemic also highlighted the potential for technology to facilitate healthcare provision. This study aimed to investigate perspectives of older adults about their understanding of anxiety, possible use of PA interventions to reduce anxiety, and whether technology could help this process.

The INDIGO trial evaluated a PA intervention for participants aged 60 years and above at risk of cognitive decline and not meeting PA guidelines. Twenty-nine of the INDIGO trial completers, including some with anxiety and/or cognitive symptoms, attended this long-term follow-up study including semi-structured qualitative interviews. Transcripts were analyzed thematically.

There was quite a diverse understanding of anxiety amongst participants. Some participants were able to describe anxiety as involving worry, uncertainty and fear, as well as relating it to physical manifestations and feeling out of control. Others had less understanding of the concept of anxiety or found it confusing. Participants generally believed that PA could potentially reduce anxiety and thought that this could occur through a “mindfulness” and/or “physiological” process. Technology use was a more controversial topic with some participants quite clearly expressing a dislike or distrust of technology or else limited access or literacy in relation to technology. Participants who were supportive of using technology described that it could help with motivation, information provision and health monitoring. Wearable activity monitors were described favorably, with online platforms and portable devices also being options.

Our results highlight the importance of increasing information and education about anxiety to older adults. This may increase awareness of anxiety and reduce delays in seeking help or not seeking help at all. Findings also emphasize the need for clinicians to support understanding of anxiety in older adults that they are seeing and provide information and education where needed. It is likely that PA interventions to reduce anxiety, with the option of a technology component with support, will be acceptable to most older adults.

Informed consent practices in healthcare are a fundamental element of patient-centred care; however, the traditional written description of the medical procedure for obtaining informed consent seems to have several limitations. Aim: This research aimed to evaluate the effects of an alternative method of obtaining informed consent, based on a short informative video for patients waiting to undergo a coronary angiography procedure in Italy.

The study involved 40 participants, 28 males and 12 females (mean age: 68.55, SD = 13.03), equally divided into two groups, one that received video informed consent and the other the traditional written one. Each group was asked to fill out two questionnaires, one created ad hoc by the authors to measure the level of understanding of the information provided and the perception of usefulness of informed consent, and the other the DASS-21 scale, able to assess anxiety, depression and stress levels.

Comparing the results of the two groups showed that informed consent via video enabled participants to better understand the information provided, as well as feel more confident in their subjective understanding of it, while perceiving informed consent via video as more useful than the traditional one. Video informed consent did not lead to higher levels of anxiety, depression, or stress among participants.

it can be hypothesized that video formats could represent a more useful and understandable alternative to traditional informed consent in the coronary angiography procedure sector.

Internet-based interventions have been explored for their potential to minimize the negative outcomes of caring, accounting for their convenient delivery, ubiquity, potential scalability and presumed (cost) effectiveness. A new online training and support programme for dementia caregivers was recently created by the World Health Organization and culturally adapted to European-Portuguese. The programme (iSupport) was developed to prevent or minimize the negative psychological effects of providing informal care to a person with dementia and relies on problem-solving and cognitive behavioural therapy techniques.

To study the usability and feasibility of the European-Portuguese version of iSupport (iSupport- Portugal).

The usability study was aimed at collecting data on user satisfaction and requirements on the programme's contents and interface. A mixed-methods design consisted of focus groups discussion and usability test sessions with informal caregivers (N=17) and health/social support professionals (N=13). The pilot study followed a mixed-methods experimental parallel between-group design with two arms (iSupport, N=21 and e-book, N=21).

The usability tests show a success rate superior to 80% in completing tasks within the platform and an excellent perception of the program's usability (M= 89.5 on the System Usability Scale). The feasibility study allowed to explore usage data for iSupport-Portugal (e.g., lessons visited, time on sessions) and explore how the intervention and control arms compare over time (baseline, 3 and 6 months after) on well-being outcomes. For a per-protocol analysis, significant group-by-time interaction effects favouring the intervention were found for anxiety (Wald χ2=6.17, p=.046) and for environmental QoL (Wald χ2=7.06, p=.029). Interviewees with the intervention arm (N=12) revealed positive impacts of iSupport on knowledge and on experiencing positive feelings.

The usability and feasibility studies of iSupport-Portugal suggest that this is a promising resource to support informal dementia caregivers. Lessons were learned on the ethical, technological, and research-related challenges for online interventions.

The use of music in older people with advanced dementia is possible because perception, sensitivity, emotion, and memory of music may remain intact after other types of memory disappear. Previous literature is controversial about stress biomarkers response to music introduction in therapy routines for people with severe cognitive impairment and neural-behavioural disorders. Particularly, for these patients, it is possible that they feel lower pleasure levels with music-based therapies.

To characterize the immediate physiological effects of listening to music during psychomotor stimulation in an old participant with combined dementia and depression disorder and in a participant with a dementia diagnosis.

Two study cases with dementia diagnosis participated in this study (P1: 84yrs; male Parkinson; FAB=9; P2: 85 yrs; female; Alzheimer; FAB=11; depression diagnosis) and were submitted to psychomotor stimulation (2 sessions). The first 20 min. of each session was dedicated to psychomotor stimulation without music (A), followed by 20 minutes with music (B). Heart rate was monitored (H10 Polar sensor) in a continuous mode. Cortisol levels were collected at the beginning of the session (T0) and then repeated at periods A and B (μg/dL). The range between minimum and maximum HR values (beats per minute- bpm) and mean values for cortisol levels were considered for the stress response analysis.

Salivary cortisol levels were higher at T0 for P1 (0.393 vs 0.203). During period A, the P1 slightly decreased their values (↓0,076) and P2 had no changes. After introducing music, both P1 and P2 increased cortisol levels (↑0,085; 0,162↑). For both P1 and P2, a wide range of HR was detected during period B (P1: 13 vs 23 bpm) vs (P2: 15 vs 41 bpm).

Immediate responses to the music inclusion in a psychomotor intervention caused an augmented stress response in elderly participants with dementia, especially in P2. In specific, the depression diagnosis in this participant may be associated with a low capacity to handle emotions during new experiences, causing a higher stress response.

elderly patients are significantly impacted by MDD and are less responsive to treatment. ECT is used more often in older patients but has its drawbacks. There is a need for for novel antidepressants. Esketamine, is a FDA approved novel treatment to treatment resistant depression(TRD). Studies of esketamine nasal spray administered with a newly initiated oral antidepressant in TRD aged patients 18-64 years demonstrated rapid onset versus a newly initiated oral antidepressant plus placebo, with maintenance of the treatment effects following long term intermittent dosing. Side effects are dose related, psychotomimetic dissociative, elevation in HR+BP, cognitive impairment, hepatotoxicity and inflammation of bladder endothelium.

to review the current data regarding esketimine treatment in elderly TRD patients.

beside several case reports only 2 RCTs checked efficiency and safety in elderly patients. A pilot RCT of titrated subcutaneous ketamine in older patients with TRD was conducted in 2017. 16 participants> 60 years with TRD who relapsed after remission or did not remit in the RCT were than administered an open label phase. Up to 5 doses of ketamine (0.1 to 0.5 mg\kg) were administered with midazolam as an active control, randomly inserted. 12 ketamine treatments were given in separate sessions at least 1 week apart. Remitters in each phase were followed up for 6 months with MADRS scale. Results provided evidence for the efficacy and safety of ketamine in treating elderly depressed. There was a significant improvement in all ketamine dosages apart from 0.1 mg/kg. 7 participants reached remission. 5/7 had relapse than entered open trial and remitted again. Ochs-Ross, et al 2020 study,138 patients with TRD> 65 years received flexibly dosed esketamine nasal spray and new antidepressant or new antidepressant with placebo. The groups did not achieve statistical significance in MADRS score change from baseline to day 28. Patients with earlier onset of depression and younger patients (65-74) showed greater response to treatment.

Esketamine is safe in elderly TRD patients. There is not enough evidence to conclude if it is efficient. It seems that patients younger than 75 and with earlier onset of depression might benefit from esketamine.

The aim of this review was to describe the usage and efficacy of Montessori senior methods of engaging the elderly with dementia reported in the existing literature.

Three databases were searched (PubMed, EMBASE, Scopus) using the key words “Montessori” “senior”. No date restrictions were placed. Inclusion criteria specified: language of the article (English), type of article (research) and the necessity of the Montessori intervention being directed at seniors.

The search initially identified 15 articles. After eliminating duplicates and evaluating titles and abstracts three studies were included in the review. One focused on staff-led Montessori interventions, and two analyzed the effectiveness and benefits of elderly-le interventions – residents of facilities who were screened using MMS and trained to provide activities for their less lower cognitive functioning peers were selected. The total number of participants from all studies was: 55 people (10 leaders and 45 participants). All three studies reported positive, statistically significant improvements in participants’ functioning. All studies used the MPES to asses psychological variables (constructive engagement (CE), passive engagement (PE), other engagement (OE), pleasure (P).

In first study (Skrajner&Camp, 2007) (CE: p<0.01 and p<0.001); OE: p<0.001, p<0.01; NE: p<0.05, p<0.01; P: p<0.01, p<0.05) classes conducted using the Montessori method were significantly more effective than those conducted using the traditional method among the same group of seniors.

Other two studies reported improvement among observations during Montessori classes scores vs scores during regular activities – Camp and Skrajner, 2004 - CE: p<0.01; OE: p<0.001; P: p<0.06); Orsulic-Jeras, Judge, Camp, 200 - CE: p<0.01, Affect Rating Scale: Pleasure: p<.001 (treatment), p<0.03 (time), Anxiety/Fear: p<0.003 (treatment), p<0.003 (time)).

The research identified indicates the positive impact that Montessori-based programmes can have on elderly people with dementia. More studies need to be conducted, because the number of participants in the current study is relatively small. Further research with larger number of participants is needed to fully prove the effectiveness of Montessori programs implemented delivered to or by older people.

Older age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. General principles of pharmacotherapy in guidelines for treating OABD are greatly like those for younger adults. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.

OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs), and antidepressants, were investigated. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.

The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilizers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilizers, lithium, FGAs, and antidepressants plus mood stabilizers significantly decreased.

Prescribing patterns changed remarkably for OABD patients over a 14- year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.

The traffic issues have been attracting global attention due to increased occurrence and higher mortality rate in the older population. Many countries have employed different kinds of regulations on the elder drivers depending either on their age or whether being demented. These policy differences left a research gap to identify the temporal relationship between serious traffic accidents (STA) and dementias, which can inform the most appropriate time for policymaking. In the present study, we linked two national databases and performed analyses to explore this problem.

With the grant and supports from the government, the research team combined the databases of STA registries and the whole population dataset of National Health Insurance Research Database to form a 10-year retrospective cohort for analyses. We performed both retrospective and prospective directions to explore the time length between STAs and the diagnoses of dementia depending on the selection of the STA occurrences and dementia diagnoses as outcomes. In addition to descriptive statistical analyses, we also performed inferential statistics to analyse the variables between different types of STAs. A p-value less than 0.05 was set as statistically significant.

437516 persons involved in STAs were enrolled for analyses and the mean age was 61.47 years (SD=8.90) with sex ratio (F/M) of 0.62. We divided the samples into three groups: (1) STAs without dementias (95.17%) (2) dementias after STAs (3.40%), and (3) dementias before STAs (1.43%). The mean age of the 3rd group (73.80 years, SD=8.79) was significantly older than the rest two. When comparing these three groups, a preceded dementia diagnosis was a significant risk factor for repeated STAs. (OR: 1.205, 95% CI: 1.100-1.320, p<0.001) Finally, an average length of 2.35 years (SD: 1.60) was found for those who was diagnosed of dementias before the first STA while 2.57 years (SD: 1.69) was noted for the diagnosis of dementia after first STA.

In our study, dementia was identified as a significant risk factor for STAs. We further asserted that 2.5 years would be an appropriate time length for the authorities to examine the traffic risks of those who were diagnosed of dementias.

Loneliness is a subjective phenomenon. It is experienced a lack of satisfying relationship to others, whether because the subject has too few relationships or because their existing relationships do not provide the desired form of closeness (Svenderson, 2017). As defined by Peplou and Perlman (1982), the definitions of loneliness share the same concept: an unpleasant, subjective experience resulting from inadequate social relationships. Loneliness and rumination are remarkable risk factors of depression among the elderly in the both community and nursing homes (Gan at al.,2015). A Norwegian study found that 56% of nursing home residents are feeling lonely (Dragaset et al.,2011). The study from Poland found that depression was observed in 33.8% long term care facility (Horwath, Scerbinska,2017). Furthermore, another study from China shown that 14.9% residents in long term facility reported suicidal ideation (Zhang at al.,2020). Associated with one being depressed in nursing homes include pain, risk of stroke, risk of heart attack, decreased cognitive function and is also linked to increased morbidity in nursing home residents, a relationship it has been also suggested for medical inpatients (Zammit, Fiorini, 2015).

The scoping review has been selected as the appropriate methodology for this study. The general purpose for conducting scoping reviews is to identify and map the available evidence (Arskley,O’Malley, 2005). Scoping reviews can be useful tools to investigate the design and conduct of research on a particular topic and conducted to review current research an identify knowledge gaps on the topic (Munn at al.,2018). According to Arksey and O’Malley (2005) the scoping review methodology is divided into six steps framework: identifying the research question, searching for relevant studies, selecting studies, charting the data, collecting the data, summarizing and reporting results and consulting with stakeholders to inform or validate study findings.

A total of 27 studies were included in the final synthesis, mixed designed studies (n=7) including questionnaires, surveys, Geriatric depression Scales, Satisfaction with life Scale, Loneliness Scale, face to face interviews and observations. Furthermore, were included quantitative studies (n=10) included one longitudinal study with 6 years follow up. Finally, were also included qualitative studies (n=10), the studies used a mixture of approach of interviews an observation. The majority of the participants were from long-term facilities (n=24), medical students and nurses were included (n=1) study and mixture of participants such as residents, family members and staff were included in (n=1) study. The most of the studies are from Norway (n=7), China (n=3), Finland (n=2), Turkey (n=2), Poland (n=2), US (n=2), Belgium (n=1), Sri Lanka (n=1), South Korea and Japan (n=1), Hong Kong (n=1), Malta (n=1), Taiwan (n=1), Iran (n=1), New Zealand (n=1) and Sweden (n=1). In Table 1, we provide a summary of the individual studies.

This scoping review highlights the importance to continue support residents’ well-being in the long-term care facilities, support their mental health and also to continue educate and support healthcare staff as they have the major impact on resident’s welfare. Previous studies indicated the correlation between loneliness and depression with demographics factors such as being married, unmarried or widowed for that reason it was recommended by Mahammadi et al. (2016) pay more attention on reducing feeling of loneliness and anxiety by increasing their life satisfaction. We found that only one study was focused on resident’s suicidal ideation (Zhang et al., 2020) who concluded from his cross-sectional study with 538 participants, age above 60 years old, from 37 nursing homes in China that 14.9% reported current suicidal ideation but we are worried that this number could be higher and we believe that needs to be done more research for the future to prevent any risk of suicide among elderly. One reason for the lack of information on suicide risk in long term facilities is that prior 2010, universal screening for suicidal ideation in these facilities had not been widely adopted nor recommended as an approach to prevent suicide (Mezuk et al.,2014).

Virtual Reality (VR)-based meditation has shown to help reduce, stress, anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults. Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful outcomes in different cultures and languages. The availability of affordable hardware raises the possibility of VR being used in low-income countries. The goal of this study is to describe and highlight some key considerations and challenges when implementing low-cost VR mindfulness interventions with older adults in Quito, Ecuador.

We created a guided mindfulness intervention using low-cost VR (smartphones and Destek V5 headsets) for older adults with anxiety in Quito, Ecuador. This project is a collaboration between the Technology and Aging Lab at McLean Hospital and the Universidad San Francisco de Quito in Ecuador. Our goal was to recruit 20 older adults with anxiety from various outpatient settings in Quito. We used the free “Sites in VR” app and selected different nature scenes for each intervention. The intervention consists of a total of 10 sessions each lasting 30 minutes. We assessed depression using the Geriatric Depression Scale (GDS), and anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7). In addition, we also administered the Mindfulness Attention Awareness Scale (MAAS) and the Behavior Activation for Depression scale (BADS).

At the time of writing, we have reached 100% of our recruitment goal and anticipate completing data analysis by January 2023. Qualitatively, our intervention revealed barriers to designing scalable VR Spanish language interventions in Latin America. Some of the main difficulties we encountered are described below: (i) There are very few virtual reality videos (360° videos) that are available for use with the DesTeK VS VR Headset in Spanish. We therefore, used a standardized Spanish narration to guide the mindfulness practice based on a script used in the United States. (ii) We found that majority of the available content is not suitable for mindfulness. Using the application Sites in VR remedied this concern, as it provides static 360° images, suitable for mindfulness. (iii) Not all technology necessary for VR interventions is readily available in Latin America: smartphones sold in Latin America do not always have a gyroscope sensor.

Mindfulness interventions using virtual reality may be an effective way to address stress and mood symptoms in older adults across cultures. However, there are many culture-specific aspects that must be addressed before applying these interventions in different cultures. This study, conducted in Latin America, is an initial step toward the establishment of best practices and standardized low-cost VR mindfulness intervention in older adults, and many aspects addressed here may be generalizable to other cultures, settings, and countries.

Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.

To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.

We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.

658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.

Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.

In nursing home residents, outcomes are often assessed using proxies, especially in residents with severe cognitive problems. Although caregivers are commonly involved as proxies, studies assessing their agreement for proxy measures are scarce. Therefore, secondary analysis was performed on a dataset with proxy-reported scores of several scales in Dutch and Flemish nursing home residents with and without dementia.

To assess the agreement between the observations of 81 pairs of caregivers, we calculated Cohen’s Kappa, Weighted Kappa, and Prevalence- and Bias-Adjusted Kappa (PABAK and PABAK- OS for ordinal data) coefficients for the items on the Nijmegen observer-rated depression scale for detection of depression in nursing home residents (NORD), the social wellbeing of nursing-home residents scale (SWON-3), and two subscales (i.e., “social relations” and “having something to do”) of the QUALIDEM. In addition, coefficients were calculated for the item concerning subjective judgment of the residents’ depressive symptoms (“no,” “yes, mild or light,” or “yes, severe”) and for the item concerning whether the caregivers believed a depression diagnosis had been established (“yes,” “no”).

In general, PABAK and PABAK-OS coefficients were higher than the Cohen’s and Weighted Kappa coefficients, suggesting a considerable amount of prevalence or bias. For the total sample, most items were above .40, indicating acceptable agreement. The results showed higher levels of agreement for proxy scores of residents with lower levels of dementia, compared to residents with more severe dementia.

The general finding of different levels of agreement between coefficients with and without correction for prevalence and bias, suggest the importance of exploring both values to enable adequate interpretation of the reliability of these items. The result of limited levels of agreement between caregivers concerning residents with more severe dementia underscores challenges for measurements in this population. We believe that practitioners and researchers should be aware of these challenges when using and interpreting scores derived from proxies. Moreover, understanding why different raters reach different conclusions regarding the same residents is important for interpreting the meaning of proxy-reported scores.

Mild behavioral impairment (MBI) is a validated diagnostic entity, that describes the emergence of later life neuropsychiatric symptoms (NPS) in pre-dementia states. The aim of this study was to estimate the prevalence of MBI in people with subjective cognitive complains (SCCs) in primary care centers and observe the evolution in a longitudinal study.

Three hundred twenty-three participants belonging to the CompAS longitudinal study who attended primary care centers with SCCs and without previous diagnosis of dementia and other neurological or psychiatric disturbances underwent clinical, neurological, and neuropsychological examinations at baseline and at two follow-up times (around 24 and 60 moths). At each evaluation point participants were diagnosed as Cognitively Unimpaired (UC), Mild Cognitive Impairment (MCI) and SDC; at the follow-up assessments dementia was diagnosed as well. Diagnosis of MBI was made via a series of semistructured independent interviews with patients and relatives in accordance with the ISTAART-AA criteria and using the Spanish MBI-C cut-off point (Mallo et al, 2019). Frequencies of participants diagnosed in each category were obtained and evolution of the MBI along the follow-up evaluations was studied.

MBI diagnosis prevalence was 22.9% at baseline corresponding to 74 individuals of which at 24 months follow-up were MBI stable 31.1%, 14.9% evolved to MCI, 1.3% to dementia and 40% to CU, (attrition 12.2%). At 60 months follow-up, from the 23 individuals with MBI, 6 remained stable (26.1%), 6 (21.1%) evolved to MCI, 2 (8.7%) to dementia, 3 (13%) to CU, (attrition 26.1%) (Figure 1).

Results indicated that almost a quarter of individuals attending primary care centers with SCCs without previous diagnosis of dementia or psychiatric disorders are MBI. An important part of them evolve to UC or MCI, and only a minority progress to dementia. More studies are needed to analyze the cognitive, personal, and biological factors that determine this evolution.

Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among elderly. In Taiwan, there are at least 300,000 people live with dementia. However, only 1.64% of people with dementia received palliative care. In this paper, we describe a real-world experience of palliative care for people with advanced dementia.

Case report.

Mrs. H, A 90-year-old illiterate woman, was referred to Home Care team after several admissions for urinary tract infection. Her past medical history included cerebral infarction with left hemiparesis 4 years ago. Over one year prior our first visit, her family had begun to notice a problem with her recent memory. Thorough investigation for dementia was arranged. She scored 11/30 on the Mini-Mental State Examination. Mixed Alzheimer’s and vascular dementia was impressed.

The Home Care service consisted of a once-monthly visit by physician and nurse. In the first year of service, we delivered active directed treatment for dementia. We also discussed nonpharmacological approaches for dealing with physical and behavior symptoms in each visit.

Then Mrs. H was hospitalized again due to fever and abdominal pain. Abdominal aortic aneurysm was diagnosed along with urinary tract infection. She had hypoactive delirium for two months after discharge. Meanwhile, Home Care team arranged a family meeting to discuss prognosis and appropriateness of palliative care. In the following two years, we focused on deprescribing and interventions for pain, dyspnea, eating problem, infection, and agitation to promote Mrs. H’s comfort and quality of life. Psychological support was crucial to facilitate continuity in carer and care setting. Mrs.H did not have burdensome transition anymore and passed away peacefully at home as her preference.

The need for palliative care in dementia is anticipated to increase over the next decades in Taiwan. In the patient presented, Home Care team acknowledged and offered palliative care to help her to live as comfortably as possible until death and to help carers cope during the course. A multidisciplinary health care is highly recommended for complex needs in dementia.